Monday, June 20, 2016

Tramadol lowers blood glucose levels
in diabetic and nondiabetic patients, according to a poster (poster
19-M) presented at the ASHP Summer Meetings in Baltimore, and health
care providers should consider glucose monitoring in patients who take
the pain medication.

Tramadol, an opioid, changes the way the brain perceives pain by
inhibiting serotonin and norepinephrine reuptake. It also activates
opioid receptors that further inhibit painful effects. Both of these
actions inhibit glucose, Larry Golightly, PharmD, a medication-use
evaluation/adverse drug reaction coordinator at University of Colorado
Hospital, in Aurora, explained in an interview with David Bronstein,
editorial director of Pharmacy Practice News.

There have been reports of patients taking tramadol for pain
requiring hospitalization because of these glucose-lowering effects,
according to Dr. Golightly. “Although it is not common, their blood
glucose can go low enough that they require hospitalization,” he said.
“Our
purpose of doing this was seeing if this was occurring in our patients
who were already in the hospital. And it looks like it was,” he said.

In
this retrospective review, they found 2,927 patients who received
tramadol during a three-year review. The patients were included in the
review if they had blood or plasma glucose concentrations measured at
least twice within five days of receiving tramadol.

They found
that hypoglycemia was reported in the chart of 22 of 47 patients with
type 1 diabetes; 113 of 673 patients with type 3 diabetes; and 103 of
2,207 patients without diabetes.

“Diabetic patients appear to be
much more susceptible to the effects of the medication than others.
Almost 20%, or one in five, diabetic patients who received tramadol
developed at least one episode of hyperglycemia,” Dr. Golightly said.

“Almost
5% of our nondiabetic patients developed at least one hypoglycemic
episode within the first five days after the drug is administered,” he
added.
There is a possibility that low glucose readings in diabetic
patients are being attributed to the patient’s condition, rather than
the drug, he said. “We can’t prove it with these data, but I think that
is exactly what is happening.”
He added that providers might consider monitoring blood glucose regardless of diabetes status in patients taking tramadol.